Long-term outcomes after definitive repair for tetralogy of Fallot with preservation of the pulmonary valve annulus.

OBJECTIVES

The aim of our study was to evaluate the long-term outcomes after definitive repair of tetralogy of Fallot with preservation of the pulmonary valve (PV) annulus.

METHODS

From 1989 to 2000, 84 of 222 patients (37.8%) with tetralogy of Fallot and PV stenosis underwent definitive repair with preservation of the PV annulus without right ventriculotomy. PV commissurotomy was concomitantly performed in 74 patients (88.1%). The PV was bicuspid in 56 patients (66.7%); the mean Z value was -1.2 ± 1.5 (range, -4.9 to 2.4). The mean follow-up period was 15.8 ± 5.7 years (maximum, 22.8), and follow-up data were complete for 75 patients (89.3%).

RESULTS

The actuarial survival and freedom from reoperation rates at 20 years was 98.6% and 95.8%. The freedom from ventricular arrhythmia at 5, 10, 15, and 20 years was 98.7%, 89.6%, 74.1%, and 58.0%, respectively. All detected ventricular arrhythmias were isolated monofocal premature ventricular contractions. Freedom from moderate or greater pulmonary regurgitation at 5, 10, 15 and 20 years was 50.4%, 44.9%, 38.4%, and 35.7%, respectively. A bicuspid PV (hazard ratio, 2.910; 95% confidence interval, 1.404-6.204, P = .004) and a Z-value of less than -2 (hazard ratio, 1.948; 95% confidence interval, 0.915-5.857; P = .034) were the risk factors for developing moderate or greater pulmonary regurgitation.

CONCLUSIONS

The long-term outcomes after definitive repair of tetralogy of Fallot with preservation of the PV annulus were excellent. Although isolated, monofocal premature ventricular contractions were frequently observed, fatal ventricular arrhythmia was not. The indication should not only be decided by the PV annulus size, but also by the valvular morphology to maintain long-term PV competency.